- And almost no one sought medical attention.
By Shannon Firth, Washington correspondent, MedPage
Six out of 10 doctors say they often experience burnout, a 20% increase from pre-pandemic levels reported in 2018, according to The Physicians Foundation's 2021 American Physicians Survey released Thursday.
A total of 46% of doctors said they had isolated themselves or withdrawn from others in the past year, more than one in three said they felt hopeless or without purpose, and 57% reported experiencing “inappropriate episodes of anger, crying, or anxiety.”
Perhaps most worrying of all is that only 14% of doctors sought medical attention for their mental health problem.
"Over the past year, the pandemic has highlighted an issue that physicians have always faced: the stigma surrounding access to mental health support and services for fear of appearing weak or believing they will lose their license and credentials," said Gary Price, MD, president of The Physicians Foundation, in a press release.
“Nearly a fifth of physicians indicated they know someone who considered, attempted, or died by suicide since the start of the pandemic alone—a time when many physicians have experienced trauma and loss,” she added. “It is vital that we make a conscious and proactive effort to end the stigma and encourage physicians to seek mental health support when they need it, especially in the wake of the most significant health event in recent history.”
When left untreated, burnout can lead to depression, anxiety, substance abuse, post-traumatic stress disorder, and suicidal thoughts, the report noted, which also highlighted that nearly 1 million Americans lose their doctor to suicide each year.
The Physician Foundation revised its biennial survey to focus on the pandemic's impact on physicians. Questions from its more traditional survey, such as those related to electronic health records and value-based pay, were omitted, but the foundation will continue to explore them in future research.
The 10-minute survey was completed online by 2,504 physicians between May 26 and June 9, 2021; it was emailed to a list of physicians taken from Medscape's proprietary database. Thirty-six percent of respondents were primary care physicians, and 64% worked in a specialty; 64% of respondents were male, 34% were female, and 2% declined to answer; and 67% of respondents were employed physicians versus 26% were self-employed, with 7% reporting their practice status as "other." Fifty-four percent of respondents were between 36 and 55 years old; 16% were between 18 and 35 years old; and 30% were 56 years of age or older.
"Difficult working conditions, such as a lack of personal protective equipment (PPE) and caring for patients who may be seriously ill for weeks, along with heavy administrative tasks, long hours and grief over the loss of patients, have become the norm, but little has been done to alleviate the high mental health cost to doctors," the report stated.
Most respondents cited family, friends, and colleagues as their most helpful sources of mental health support during the pandemic, according to the survey.
Regarding burnout rates, the report found that more female physicians (69%) experienced feelings of burnout than male physicians (57%).
The fact that both younger and female physicians were more likely to report burnout could be related to the "dual role" of female physicians as clinicians and as "primary homemakers" or "childcare providers" in the family, the report's authors said. They explained that research has found that female physicians do an average of 8.5 hours more work from home than their male medical colleagues, "which contributes significantly to the risk of burnout."
Regarding the financial health of physicians and changes in their workplace, 49% of physicians said their income has decreased, 32% saw staff reductions, and 18% transitioned their practice to a primarily telemedicine model.
Delving deeper into the issue of declining income, the report found that 68% of physicians who reported working independently saw a reduction in income, compared to 44% of physicians working for a hospital or healthcare system. Furthermore, a higher proportion of physicians who were male and aged 46 or older experienced a decrease in income.
Only 9% of independent physicians reported that they moved to a new practice or changed their employment status.
Most doctors said they anticipate telemedicine will play a bigger role in their practice, that they expect an increase in more serious health problems as patients delay visits due to lockdowns, and a majority predict there will be "significantly fewer" independent practices once the pandemic is over.
A total of 23% of physicians, across a variety of demographic groups, said they want to retire next year, down from 38% who reported wanting to retire in 2020.
Returning to mental health issues, the report found that more than half of the doctors said they know a doctor who has considered, attempted, or died by suicide since the start of the pandemic.
The suicide rate among male physicians is approximately 1.41 times higher than in the general male population, and for female physicians that risk is even higher, 2.27 times higher than the general female population.
Eight percent of physicians reported increased weekly use of medications, alcohol, or illicit drugs.
More than seven out of 10 physicians supported a comprehensive approach to addressing mental health conditions, including confidential therapy or counseling or support lines, peer support groups, and evidence-based training to prevent burnout, behavioral health problems, and suicide.
Nearly three-quarters of respondents supported a "change or elimination of medical leave questions that stigmatize access to behavioral health care."